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目的总结分析残胃癌的临床病理学特征。方法回顾性分析2000年3月至2008年5月期间川北医学院附属第二医院和中国人民解放军总医院共114例残胃癌的临床病理学资料。依据原发疾病性质分为良性疾病组和恶性疾病组进行分析。结果本组114例患者,年龄(62.6±11.3)岁,男∶女=4.7∶1.0。76.2%(64/84)的患者诊断时处于进展期(以pT分期为依据),pT1期病例仅占23.8%(20/84),60.7%(51/84)的病例达pT4期。残胃癌的一般病理特征:pT4b(27.4%,23/84)、pN+(42.9%,36/84)及cM1(27.2%,31/114)常见,93.5%(29/31)的远处转移位于腹腔,腹膜转移最高达67.7%(21/31)。组织学分化程度以低分化腺癌最常见(76.7%,79/103),Laurén分型以弥漫型最常见(78.6%,81/103)。良、恶性原发疾病间首次采用的手术方式和重建方式差异均有统计学意义(均P=0.000)。中位发病时间(潜伏期)良性组∶恶性组=30.0年∶3.3年(P=0.000),主要受原发疾病性质、首次手术时年龄的影响(P<0.05)。良、恶性组间的病理学指标比较,除是否为印戒细胞癌(P=0.045)、是否侵犯周围脏器(P=0.049)、pN分期(P=0.025)及Borrmann分型(P=0.005)差异有统计学意义外,其余病理学指标以及手术切除率、R0切除率和生存率差异均无统计学意义(P>0.05)。结论残胃癌的主要临床病理学特征基本上不受原发疾病性质的影响,建立个体化的内镜随访程序是必要和可行的。
Objective To summarize the clinicopathological features of gastric stump carcinoma. Methods A retrospective analysis of clinic pathology data of 114 gastric cancer patients from the Second Affiliated Hospital of North Sichuan Medical College and General Hospital of Chinese PLA from March 2000 to May 2008 was performed. According to the nature of the primary disease is divided into benign disease group and malignant disease group for analysis. Results A total of 114 patients (62.6 ± 11.3 years) with a male: female = 4.7: 1.0.76.2% (64/84) were diagnosed with advanced stage (based on pT stage), and pT1 only accounted for 23.8% (20/84) and 60.7% (51/84) cases reached the stage of pT4. The general histopathological features of gastric cancinoma: pT4b (27.4%, 23/84), pN + (42.9%, 36/84) and cM1 (27.2%, 31/114) were common, and distant metastasis was 93.5% (29/31) Abdominal, peritoneal metastases up to 67.7% (21/31). Histologically differentiated with poorly differentiated adenocarcinoma was the most common (76.7%, 79/103). The Laurén type was the most common (78.6%, 81/103) with diffuse type. There was significant difference in the surgical methods and reconstruction methods used for the first time between benign and malignant primary diseases (both P = 0.000). The median time to onset (latency) of the benign group: malignant group = 30.0 years: 3.3 years (P = 0.000), mainly due to the nature of the primary disease, the age of the first operation (P <0.05). (P = 0.049), pN stage (P = 0.025) and Borrmann’s type (P = 0.005), whether or not signet ring cell carcinoma (P = 0.045) ) Was statistically different, the other pathological indicators and surgical resection rate, R0 resection rate and survival rate difference was not statistically significant (P> 0.05). Conclusion The main clinical and pathological features of gastric stump cancer are basically unaffected by the nature of the primary disease. It is necessary and feasible to establish a personalized endoscopic follow-up procedure.